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báo cáo khoa học: "Brain herniation in a patient with apparently normal intracranial pressure: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Brain herniation in a patient with apparently normal intracranial pressure: a case report | Dahlqvist et al. Journal of Medical Case Reports 2010 4 297 http www.jmedicalcasereports.eom content 4 1 297 jAg JOURNALOF medical ÌỤr case REPORTS CASE REPORT Open Access Brain herniation in a patient with apparently normal intracranial pressure a case report 1 2 2 11 1 Mats B Dahlqvist Robert H Andres Andreas Raabe Stephan M Jakob Jukka Takala Martin W Dunser Abstract Introduction Intracranial pressure monitoring is commonly implemented in patients with neurologic injury and at high risk of developing intracranial hypertension to detect changes in intracranial pressure in a timely manner. This enables early and potentially life-saving treatment of intracranial hypertension. Case presentation An intraparenchymal pressure probe was placed in the hemisphere contralateral to a large basal ganglia hemorrhage in a 75-year-old Caucasian man who was mechanically ventilated and sedated because of depressed consciousness. Intracranial pressures were continuously recorded and never exceeded 17 mmHg. After sedation had been stopped our patient showed clinical signs of transtentorial brain herniation despite apparently normal intracranial pressures less than 10 mmHg . Computed tomography revealed that the size of the intracerebral hematoma had increased together with significant unilateral brain edema and transtentorial herniation. The contralateral hemisphere where the intraparenchymal pressure probe was placed appeared normal. Our patient underwent emergency decompressive craniotomy and was tracheotomized early but did not completely recover. Conclusions Intraparenchymal pressure probes placed in the hemisphere contralateral to an intracerebral hematoma may dramatically underestimate intracranial pressure despite apparently normal values even in the case of transtentorial brain herniation. Introduction Elevated supratentorial intracranial pressure ICP can cause transtentorial brain herniation leading to cerebral hypoperfusion brainstem herniation and ultimately death if .